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Active engagement: Strategies to increaseservice participation by vulnerable families

IntroductionThis Research to Practice Note provides a briefoverview of the key issues presented in the literaturereview about active engagement of families in earlyintervention programs.

It aims to provide both caseworkers and agencieswith a list of strategies designed to increase theuptake and retention of services by families in early intervention programs.

What is active engagement?Active engagement strategies are those designed to increase the rate of enrolment and retention inintervention programs. They have been devised in response to high refusal and attrition ratesexperienced by programs.

It is now well established that it is important tointervene early if more serious problems are to beavoided later in life1. However, research indicatesthat families at highest risk for child maltreatment as well as other parenting difficulties are those leastlikely to take up primary health services. And, ifthey do enrol they are more likely to drop outbefore completing the program2.

Those most likely to drop out were older motherswith larger numbers of children3. As well, beingemployed also made attendance less likely4.

Active engagement strategies can be at an agency or an individual caseworker level.

What strategies increase initial uptakeof services?Strategies employed to increase initial uptake ofservices have varying levels of evidence supportingtheir use. These strategies are listed below.

The number of asterisks reflects thestrength of the evidence as follows:

* reflects claims made by clinicians or service providers but without any detail as to the difference anintervention made

** reflects claims made by researchers,clinicians or service providers with some limited data as evidence (for example, based on pre and postcomparisons in terms of percentages)

*** reflects that there has been somestatistical analysis of two groups. If Random Control Trials are used this has been identified in the text.

Caseworker level

• Contact parents/carers within 48 hours of them being referred5.*

• Visit families in the home initially before offering a clinic based intervention6.**

• When visiting a family for the first time,accompany a worker already known to the family.*

• Follow up on participants one week after initial contact7.***

• During the first four months, make weeklycontact with the families8.*** If families do not return a call, fail to keep an appointment or are not at home at the pre-arranged time,persist with the contact attempting at least three9* or four times10.**

• Where appropriate, visit mothers at least once prior to the birth of their child11.***

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Agency level

• When introducing a new service to an area,allow enough time to promote and engage the support of key agencies.*

• Recruit families through the community rather than ‘authorities’12.**

• Offer services during transition periods, eg. the antenatal period (first child, starting school).***

• Give caseworkers a title that reflects a supportive rather than an intervention role to avoid families feeling stigmatised13.**

What strategies increase retention rates?

Caseworker level

• Build a trusting relationship14.**

• Adopt a supportive role15.***

• Provide support that is useful, eg. provide concrete services16.**

• Focus on practical skill building17.*

• Do not adopt a punitive approach18.**

• Frame questions in a non-judgmental way.*

• Use verbal encouragement and avoid official and officious sounding language19.*

• Send a letter or phone beforehand to remind of appointment20, 21.**

• Be punctual and reliable, try not to cancelappointments or cut them short22.***

• Include families in decision-making, eg. offer a couple of strategies and let the parent decide what they think might work for them23.*

• Empower parents so that parental confidence is increased24.**

Agency level

• Promote the service to increase awareness of its availability25.*

• Provide multiple gateways into the service26.*

• Reduce eligibility criteria to increase the rate of service uptake27.*

• Accessing support should require minimal effort by the families, eg. provide transport28.***

• Provide flexibility, eg. weekend or eveningappointments29.**

• Provide free child care during the programs for parents30.*

• Participation should not result in financialdisadvantage for the families.

• Provide a toll-free number31.**

• Provide some food.*

• Where possible, match participants andproviders in terms of parenting status, age and ethnicity32.**

• Encourage the reception staff to be warm and welcoming33.*

• Provide stability by using the same caseworker34.*

• Organise and hold social events within a community so that families can build up informal supports.*

• Evaluate outcomes not throughput35.**

Agency-caseworker interface

• Provide caseworkers with a manageablecaseload, for example 10 to 25 families,depending on their level of need36.**

• Provide caseworkers with supervision37.**

• Caseworkers need to be able to access brokerage funds quickly to deliver to families quickly38, 39.**

• Train staff in programs that are culturallyappropriate.*

ConclusionIt is important to make services attractive to families. If they feel threatened or if by attendance, they arelabelled as failures, they will feel uncomfortableattending. Other agencies will also not refer to aprogram unless they see merit in it, so relationshipsneed to be built within the service providercommunity.

It is clear that if providers are not able to provideeffective services and the situation deteriorates, more intensive and expensive services will beneeded.

For parents receiving statutory child protectionservices, the engagement in, and timely completion of, treatment is part of a specified service plan.Noncompliance with that plan can result in theremoval of children and their placement in fostercare and, ultimately, termination of parental rights.

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Further reading• Active Engagement: Strategies to Increase

Service Participation by Vulnerable Families,NSW Department of Community Services, 2005

Endnotes1 Shonkoff, J. P. & Phillips, D. A., (2000). From neurons to neighborhoods:

The science of early child development. Washington: National Academy Press

2 Sanders, M & Cann, W. (2002). Promoting positive parenting as an abuse prevention strategy, in K. Browne, H.Hanks, P.Stratton & C. Hamilton (eds). Early Prediction and Prevention of Child Abuse: A Handbook. Wiley, Chichester

3 Katz, K, S., El-Mohandes, A., Johnson, D.M., Jarrett, M., Rose, A. &Cober, M. (2001). Retention of low income mothers in a parentingintervention study. Journal of Community Health, 26(3), 203-218

4 Daro, D., McCurdy, K., Falconnier L. & Stojanovic, D.(2003).Sustaining new parents in home visitation services: key participantand program factors. Child Abuse & Neglect, 27, 1101-1125

5 Dawson, K & Berry, M. (2002). Engaging Families in Child welfareservices: an evidence-based approach to best practice. Child Welfare,81(2), 293-317

6 Naughton, A. & Heath, A. (2001). Developing an early interventionprogramme to prevent child maltreatment. Child Abuse Review,10, 85-96

7 Katz et al, 2001

8 Ibid

9 Tomison, A. (2002) personal communication

10 Senturai, Y.V., Mortimer, K, M., Baker, D., Gergen, P.,Mitchell, H.Joseph, C. & Wedner, H.J (1998). Successful techniques for retentionof study participants in an inner-city population. Controlled clinicaltrials, 19, 544-554

11 Gomby, D.S., Culross, P.L. & Behrman, R. E. (1999). Home visiting:Recent program evaluations–analysis and recommendations. The Future of Children, 9 (I), 4- 26

12 Hamner T.J. & Turner P.H. (2000). Parenting in Contemporary Society.Allyn & Bacon

13 Aldgate J & Statham, J (2001). The Children Act Now, Messages from Research. Report for the Department of Health. London, The Stationery Office

14 Lee, C.D. & Ayón, C. (2004). Is client-worker relationshipassociated with better outcomes in mandated child abuse cases.Research on social worker practice, 14(5), 351-357

15 Dawson et al, 2001

16 Littell, J.H. & Tajima, E. A. (2000). A multilevel model of client participation in intensive family preservation services.Social Services Review, 74, 405-435

17 Macdonald, 2001; Whittaker, Schinke & Gilchrist, 1986, cited in Dawson & Berry, 2003

18 Dawson et al, 2002

19 Aldgate et al, 2001

20 Naughton et al, 2001

21 Senturai et al, 1998

22 Gomby et al, 1999

23 Aldgate et al, 2001

24 Johnson Z Howell F & Molloy B, (1993). Community mother’sprogramme: randomised controlled trial of non-professionalintervention in parenting. British Medical Journal, 306: 1449-1452

25 Kovacs, K (2003). How accessible are child abuse services. Family Matters (64):48-51

26 Giard, J., Hennigan, K., Huntington, N., Vogel, W., Rinehart, D.,Mazelis, R., Nadlicki, T. & Veysey, B.M. (2005). Development and implementation of a multi-site evaluation for the women, co-occurring disorders and violence study. Journal of CommunityPsychology, 33(4), 411-427

27 Aldgate et al, 2001

28 Katz et al, 2001

29 Senturai et al, 1998

30 Tomison, A. (1998). Targeting ‘at risk’ families. An evaluation of the Brimbank Family outreach service. National Child Protection Clearing House. Newsletter 6(2) 3-6

31 Giard et al, 2005

32 Daro et al, 2003

33 Aldgate et al, 2001

34 Senturai et al, 1998

35 Giard et al, 2005

36 Baronet, A-M. & Gerber, G. J. (1998). Psychiatric rehabilitation:Efficacy of four models. Clinical psychology review, 18(2), 189-228

37 McGuigan, W.M., Katzev, A. R. & Pratt, C. C. (2003). Multi-leveldeterminants of retention in a home visiting child abuse preventionprogram, Child Abuse & Neglect, 27, 363-380

38 Spice consultants (2001). An evaluation of Strengthening Familiesinitiative. Government Report

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